Curious Case of Rising Death Rates
History is not only the study of past events. It is also the study of technology we use to study these events. As technology advances, so does our understanding of history.
For much of American history, healthcare was seen as distinct from other aspects of a person’s life. But now we are learning that broad social policy affects our individual health, revealing connections we were previously unaware of.
This month, the National Bureau of Economic Research (NBER) released a report analyzing America’s death rate. The report compared mortality among Black and White Americans, and their European counterparts.
Overall life expectancy is lower in the United States than in Europe. But inequalities in the life expectancies among different demographics in America are more pronounced than in Europe. In the United States, life expectancy between the wealthy and the poor remains significant. In Europe, life expectancy between financial classes is relatively the same.
Black Americans have higher mortality and shorter life spans. But since 1990, they reduced the life expectancy gap with White Americans by half, though the disparity remains fixed since 2012.
The trends revealed in the report are complex and do not follow a simple cause and effect relationship. But there is one consistent factor that significantly affected mortality and life span – across racial lines and continents – wealth.
Wealthier European nations with lower poverty rates had lower mortality. Well-educated, wealthy Black Americans live longer than uneducated, poor White Americans.
The analysis is clear. Wealth and education impact health. The broad economic policies and educational standards in a country have a direct impact on an individual’s life span. We have known for many years that social determinants affect a patient’s quality of care and clinical outcomes. But these studies were largely confined to individual analysis.
We now know that broad financial and educational policies affect individual health. That what appears in the macro affects the micro.
The report from the NBER was the first to cross-correlate healthcare and financial data across different countries over multiple decades. And it has conclusively demonstrated that macroeconomic trends affect individual health.
In our excitement, we may rush to conclusions. We may believe that European-style universal healthcare is a better model of care, or that income redistribution will increase longevity of life. We should resist such hasty judgments.
Although the data demonstrates clear, undeniable trends correlating broad policy with individual health, we should remember they are trends, not definitive conclusions. We cannot take trends and draw policy conclusions from them. In the past, when we have done that with healthcare data we create with new, unanticipated issues.
Sometimes a relationship in healthcare is best understood as a trend. Different people have different baseline blood pressure levels. But the trend in blood pressure levels matters more than just the baseline level when treating hypertension.
Similarly, the trends correlating fiscal policy with individual patient mortality cannot prove one economic model is better than another. The trends can only show marginal improvements in mortality based upon changes in policy.
But that alone is powerful.
Now that we know correlations exist between fiscal policy and individual healthcare outcomes, we can apply the same study methods to data localized within a given city or state to study healthcare implications of certain policy decisions.
Suppose a county board wants to raise sales tax. Previously we could only infer whether the additional tax would help or hurt the county. We now have a method to study the direct implications of that tax on individual healthcare outcomes.
The NBER report provides a framework to analyze patient behavior by redefining healthcare policy outside of its traditional definition, encompassing broad fiscal and economic policies. Now a tax is no longer just a tax. It is a driver of patient outcomes and should be evaluated relative to its impact on patient outcomes.
The more we study healthcare relative to broader socioeconomic issues, the better we understand the correlations that exist in society. The more correlations we find, the better we understand healthcare.
Soon we will recognize that healthcare is not just the care we provide, but also the policies we enact.
Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021
Outpatient Visits for COVID-19 and Associated Antibiotic Prescriptions Among Medicare Beneficiaries Aged 65 Years or Older, by Setting, US, April 2020 to April 2021. The volume of COVID-19 visits differed by setting: emergency department, 525 608 (45.8% of all visits); office, 295 983 (25.3%); telehealth, 260 261 (22.3%); and urgent care, 77 268 (6.6%).
Source: Journal of American Medical Association Network